Ingestive behavior and obesityObesity and quality of life
Introduction
The other articles in this special issue of Nutrition provide a thorough review of the literature on key topics, including genetic and metabolic control systems, that govern regulation of body weight, the biological systems that control hunger and satiety, the use of current and future pharmacologic agents, and obesity-related morbidity and mortality. In contrast, this review provides a unique perspective on obesity from the patient’s point of view. By using health-related quality of life (HRQL) instruments, we are able to gain insight to the patients’ subjective experience of being overweight: to capture their feelings, values, abilities, and expectations. We can use these instruments to assess their perceptions of what it is like to be obese and the changes that result from various weight-reduction interventions. Over the past decade, evaluation of HRQL has become an essential clinical and research outcome measurement. It is important to remember that the primary therapeutic goal of any obesity intervention is to improve the patient’s outlook and not simply promote weight loss.
Section snippets
Measurement of health status and quality of life
When patients are asked why they are seeking treatment for obesity, their responses are generally related to disappointment with their appearance or difficulty with daily physical functioning due to shortness of breath, pain of the weight-bearing joints, low energy levels, and/or reduced mobility. Other patients may present with psychological concerns such as low self-esteem and disturbance of body image. Occasionally, patients will relay other health-related concerns, such as newly diagnosed
Obesity HRQL measurements
At the time of this writing, we were able to identify five obesity HRQL instruments published in the medical literature (Table I). In general, the process used to construct the instruments was quite similar: obese patients and/or health professionals who treat this population were asked to generate questions (items) that represent relevant complaints and concerns. For most, the initial list of items was then modified and evaluated for test–retest reliability. Items were then categorized under
Impact of obesity on general health
The impact of obesity on overall daily functioning and quality of life is best measured by general health perceptions using several HRQL domains, including general health, physical, social, and emotional functioning, and vitality. Individuals with obesity uniformly perceive their general health as poorer than do healthy-weight individuals.1, 10, 11, 12 Moreover, a continuum has been observed between mildly, moderately, and severely (morbidly) obese individuals and worsening perceived health
Effects of obesity on physical functioning
Obesity places several physiologic demands on multiple organ functions that are physically perceived by the individual, most notably the heart and vascular system (blood and oxygen exchange), respiratory system (oxygen and carbon dioxide exchange), musculoskeletal system (mobility and weight bearing), and skin (heat loss and hygiene). The effect of obesity on the skin is particularly noticeable by increased sweating, cutaneous infections, and swelling and/or discoloration of the lower
Effects of obesity on psychological functioning
Despite the serious physical consequences associated with obesity, an expert panel, composed predominantly of physicians, concluded: “Obesity creates an enormous psychological burden. In terms of suffering, this burden may be the greatest adverse effect of obesity.”24 Numerous population studies have shown few significant differences between obese and non-obese participants on standardized measures of psychopathology (for review, see Wadden and Stunkard25). Body-image dissatisfaction26 and
Effects of weight loss on quality-of-life measurements
Given the significant adverse consequences of obesity and their effect on quality of life, it is imperative to assess whether weight loss improves the quality of life for obese patients.46 Numerous studies have assessed quality of life before and after weight loss, but fewer have included no or minimal weight-loss controls. The studies reviewed in this article assessed quality of life before and after weight loss and included appropriate controls.47, 48, 49, 50, 51, 52 Several studies have
References (53)
- et al.
Quality of life and the overweight; the Obesity Related Well-Being (Orwell 97) Questionnaire
Addict Behav
(1999) - et al.
Risk factors associated with symptoms of gastroesophageal reflux
Am J Med
(1999) Dieting and the search for the perfect bodywhere physiology and culture collide
Behav Ther
(1991)- et al.
A health status assessment of the impact of weight loss following Roux-en-Y gastric bypass for clinically severe obesity
J Am Coll Surg
(1999) - et al.
Quality of life assessment of morbidly obese patientseffect of weight-reducing surgery
Am J Clin Nutr
(1998) - et al.
The realistic treatment of obesitychanging the scales of success
Clin Psychol Rev
(1994) - et al.
“Specific” scale compared with “generic” scalea double measurement of the quality of life in a french community sample of obese subjects
J Epidemiol Comm Health
(1998) The impact of obesity on health statussome implications for health care costs
Int J Obesity
(1995)The status of health assessment 1994
Annu Rev Public Health
(1995)- et al.
Health status, quality of life, and the individual
JAMA
(1994)
Users’ guide to the medical literature. XII. How to use articles about health-related quality of life. Evidence-based medicine working group
JAMA
The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection
Med Care
The Sickness Impact Profiledevelopment and final revision of a health status measure
Med Care
A critical appraisal for the quality of quality-of-life measurements
JAMA
Assessing impact of weight on quality of life
Obesity Res
Assessing health-related quality-of-life, and health state preference in persons with obesity
Qual Life Res
The Obesity Adjustment Surveydevelopment of a scale to assess psychological adjustment to morbid obesity
Int J Obesity
Health-related quality of life in obese persons seeking treatment
J Fam Pract
The relation between overweight and subjective health according to age, social class, slimming behavior and smoking habits in Dutch adults
Am J Public Health
Functional status and emotional well-being, dietary intake, and physical activity of severely obese subjects
J Am Diet Assoc
Obesity and urinary incontinence in women
Br J Obstet Gynaecol
Impairment of health and quality of life using new US federal guidelines for the identification of obesity
Arch Intern Med
Pain in the obeseimpact on health-related quality of life
Ann Behav Med
The prevalence of low back pain and associations with body fatness, fat distribution and height
Int J Obesity
Traffic accidents in commercial long-haul truck driversthe influence of sleep-disordered breathing and obesity
Sleep
Impact of self-reported sleep-breathing disturbances on psychosocial performance in the Swedish Obese Subjects (SOS) study
Sleep
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